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Couple Struggles After MassHealth Benefits Pulled

Plymouth Couple Uncertain How They Will Pay Multiple Sclerosis-Related Bills

2:43 p.m. EDT July 22, 2003
Plymouth, Mass.

A Plymouth couple is wondering how they will continue to pay their steep medical bills after MassHealth pulled their health coverage following a slight increase in their social security income.

Newscenter 5's Liz Brunner reported that last month, Gary and Melody McAuley received notification that their MassHealth benefits, used to cover Gary's medical bills associated with multiple sclerosis, will be terminated.

Gary McAuley described the toll the disease has taken on his health.

"If you look around the apartment, 18 months ago I was able to get around using canes, then a walker. But in the last five months I've gone to the wheelchair just because I can't walk five feet," said Gary McAuley.

Last December, McAuley and his wife, Melody, moved to Plymouth from Tennessee to be closer to Gary's family and escape the hot weather that makes his disease worse. Gary can't work and has been on the state's MassHealth insurance program. But last month he received notification those benefits were terminated.

"I'm assuming it's because I'm working. They haven't clarified that," said Melody McAuley.

According to MassHealth, the family now makes too much income to receive MassHealth benefits by about $200 a month.

"We're not just trying to beat anyone out of anything. We're just trying to survive. And you know, now this comes along and it's going to make it that much more difficult to survive," said Gary McAuley.

Melody hasn't had any health insurance since they moved. She said the money she makes in her part time job just helps pay for food and other bills. But there's no way they can put out $900 a month for Interferon, a drug they say keeps Gary from deteriorating rapidly.

"It's hell because at least today, if he had to, he could stand up and do things for himself when I'm not here during the day. But it would scare me to be gone and him not have it because if he falls, and basically it's like he has no legs underneath him. And his health goes down hill, it's like a totally different person, he has no energy, he just sits because that's all he can do," said Gary McAuley. "It will be a matter of months before I'm not able to get off the couch, to use the bathroom, to just get out of bed by myself anymore. And I know that's something that's in the future. I would rather it would be six years from now, not six months."

According to MassHealth and Human Services, the McAuley's do qualify for another state health insurance program called CommonHealth. It covers nonworking disabled adults whose gross income is above 133 percent of the federal poverty level. There's a small monthly premium, but you qualify only after spending $6,000 out-of-pocket in medical expenses.

"We don't have $6,000. It would take me months to even get close to that," said Melody McAuley. "We don't have a bank account. Everything we have goes right back out."

At the end of the month, Gary McAuley's medication runs out. Melody is hoping her employer may one day offer her full-time job with benefits.

"MassHealth is saying he will be OK without this. Where am I going to get the means to take care of him? They were all I had left," said Melody McAuley.

MassHealth declined an interview for this story, but released a statement that said the Commonwealth's requirements for state subsidized health coverage are much more liberal than in many other states.

Gary McAuley said the company that makes his injectable medication may discount his prescription.

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